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Leap Into The Awful Unknown

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Another Krugman Analysis Of Republican / Trump Healthcare

Hard-core libertarians, for example, don’t believe making health care available to those who need it is a legitimate role of government; letting some citizens go bankrupt and/or die if they get sick is the price of freedom as they define it.

But Republicans have never made that case. Instead, at every stage of this political fight they have claimed to be doing exactly the opposite of what they’re actually doing: covering more people, making health care cheaper, protecting Americans with pre-existing conditions.

We’re not talking about run-of-the-mill spin here; we’re talking about black is white, up is down, dishonesty so raw it’s practically surreal. This isn’t just an assault on health care, it’s an assault on truth itself.

Will this vileness prevail? Your guess is as good as mine about whether Mitch McConnell will hold on to the 50 senators he needs. But the mere possibility that this much cruelty, wrapped in this much fraudulence, might pass is a horrifying indictment of his party.

Healthcare – Numbers Matter

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Republican Politicians and Trump are masters at using words to deceive the actual implications of policy actions. No so much with numbers. The house healthcare bill is a good example. In an earlier post I attempted to put in context the pittance of money they were throwing at the problem to justify taking away healthcare for millions of Americans that depend on the ACA – $8 Billion over five years for “High Risk Pools.”

I learned many years ago, while working in the Office of Secretary of Defense for Systems Analysis, that quantifying consequences is critical for laying bare the implications of misleading / self-serving political statements.

Beware of what the Senate Republicans are saying and trying to get through. The Republicans and Trump are attempting to drastically cut Medicaid and make other changes that will take away healthcare for millions of Americans and increase costs for the rest of us. All of this to justify giving a tax break to wealthy people.

Look at the facts and consequences:

  • Roughly 70 million Americans depend on Medicaid.
  • Medicaid’s costs per beneficiary are substantially lower than if covered by private insurance. Specifically, a Kaiser Family Foundation issue brief  sited research results that total healthcare estimated spending would increase nearly 26 percent, from $5,671 per person per year to $7,126, if a typical low-income Medicaid adult were covered by private health insurance for a full year. In addition, total health care spending would increase 37 percent, from $909 per child per year to $1,247, if a low-income Medicaid or CHIP-enrolled child were covered instead by private health insurance for a full year.
  • The Center For Budget And Policy Priorities, in Frequently Asked Questions About Medicaid, reported that “Medicaid’s costs per beneficiary are substantially lower than for private insurance and have been growing more slowly than per-beneficiary costs under private employer coverage.”

Medicaid Spending per Beneficiary Has Grown More Slowly Than Private Insurance

  • We are waiting to hear from the CBO on the latest assessment of the Senate bill, but it is almost certain to report that (1) 20 plus million people will lose healthcare coverage provided through Medicaid and other ACA provisions, (2) The insurance industry will get a pass on providing coverage for people with pre-exsiting conditions, (3) the state insurance markets will fail, (4) insurance rates will increase for everyone except perhaps for young adults, and (5) we will continue to have the most inefficient healthcare system in the western world — one that consumes over 20 percent of our 10 trillion dollar economy.

These are the facts but they will not be in the Republican or Presidential statements and press releases.

An Alice Rivlin Quote

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This is worth reading. I hope Trump and the Congressional Republicans read it!

How Republicans can save their health care legacy

If some version of the Republican reconciliation bill to repeal and replace the Affordable Care Act (ACA) squeaks through both the Senate and the House after the July 4 recess, it will be the first major health care law created by Republicans without a single Democratic vote.

Republicans who care about the future of their party should ask themselves whether they want their label on an unpopular, cobbled-together bill that satisfies neither conservatives nor moderates and is easy for opponents to demonize. Do Republicans really want to be sole owners of a law that deprives millions of working class Americans of health coverage, risks destabilizing health insurance markets, hands huge tax benefits to extremely wealthy people, and is opposed by virtually all health provider organizations?

More On The Three Legs of Insurance-Based Healthcare

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As I have written previously, a single payer system would be less costly and preferred to the ACA or the Republican replacement. But the political reality is not there so we are faced with the alternative, the three legs of insurance-based healthcare. as explained by Krugman: Three Legs Good No Legs Bad.

So the Affordable Care Act went for incrementalism — the so-called three-legged stool.

It starts by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of pre-existing conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on.

So insurance regulation has to be accompanied by the individual mandate, a requirement that people sign up for insurance, even if they’re currently healthy. And the insurance must meet minimum standards: Buying a cheap policy that barely covers anything is functionally the same as not buying insurance at all.

But what if people can’t afford insurance? The third leg of the stool is subsidies that limit the cost for those with lower incomes. For those with the lowest incomes, the subsidy is 100 percent, and takes the form of an expansion of Medicaid.

So what does Krugman have to say about the Senate bill:

First, they’re dead set on repealing the individual mandate, which is unpopular with healthy people but essential to making the system work for those who need it.

Second, they’re determined to slash subsidies — including making savage cuts to Medicaid — in order to free up money that they can use to cut taxes on the wealthy. The result would be a drastic rise in net premiums for most families.

Finally, we’re now hearing a lot about the Cruz amendment, which would let insurers offer bare-bones plans with minimal coverage and high deductibles. These would be useless to people with pre-existing conditions, who would find themselves segregated into a high-cost market — effectively sawing off the third leg of the stool.

So which parts of their plan would Republicans have to abandon to avoid a huge rise in the number of uninsured? The answer is, all of them.

Republican Cruelty

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Another post that is not directly about Trump (but he is one of the tribe and is a clear facilitator). It is about Republican Cruelty. Concerning healthcare, Paul Krugman and Timothy Egan say it best:

Paul Krugamen first: Understanding Republican Cruelty:

So one way to understand this ugly health plan is that Republicans, through their political opportunism and dishonesty, boxed themselves into a position that makes them seem cruel and immoral — because they are.

…this story began with a politically convenient lie — the pretense, going all the way back to Ronald Reagan, that social safety net programs just reward lazy people who don’t want to work. And we all know which people in particular were supposed to be on the take.

Now, this was never true, and in an era of rising inequality and declining traditional industries, some of the biggest beneficiaries of these safety net programs are members of the Trump-supporting white working class. But the modern G.O.P. basically consists of career apparatchiks who live in an intellectual bubble, and those Reagan-era stereotypes still dominate their picture of struggling Americans.

Or to put it another way, Republicans start from a sort of baseline of cruelty toward the less fortunate, of hostility toward anything that protects families against catastrophe.

Timothy Egan also addresses the Cruelty of the healthcare bill, The Blood on a Tax Cut. “The toxic Senate bill is the broadest attach on working Americans by a governing political party in our lifetime.”

There is blood on this tax cut. It’s a simple swap — taking away $700 billion from one class of people to give it to another. That swap would leave 22 million Americans without health care over the next decade, and many of them will die prematurely because they will not see a doctor in time. In turn, those making $875,000 a year would get an average tax cut of about $45,000. Those making $5 million a year would get a break of $250,000.

The Real Reasons The WWC Support Trump

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This post is not about Trump. He understands how to garner the White Working Class vote, Make America Great Again.

This post is about the clueless Democrats. Their focus is on throwing rocks at Trump rather than addressing the real problem of why the WWC have abandoned them for someone like Trump. The motivation for this post is a thoughtful article that goes a long way to explaining the reasons why.

What So Many People Don’t Get About the U.S. Working Class

The article appears in the Harvard Business Review and was written by Joan C. Williams. She is Distinguished Professor of Law and Founding Director of the Center of WorkLife Law at the University of California, Hastings College of the Law. Her newest book is the forthcoming White Working Class.

Taking From The Poor & Giving To The Rich

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Trump will sign any healthcare legislation that the Republicans send him. He has no empathy. He does not care.

The republicans likewise have no empathy. They do not care. They are in the pockets of the insurance industry and wealthy. Their healthcare bill is a terrible piece of legislation.

  • It will discriminate against the poor, elderly and sick.
  • I will facilitate a tax break for the wealthy.
  • It will allow insurance to cherry-pick based on pre-exisiting conditions.

Consider this: The administrative costs of government-run Medicare is about 1%. In contrast insurance takes 10 to 20 percent off the top for the task of distributing money to healthcare providers.

This 10 to 20 percent cost is huge given that healthcare is between 1/6th and 1/5th of the national economy (between at least 3 trillion and 3.6 trillion of our 18 trillion dollar economy). By going to a single payer system, and getting the insurance industry out of the money-transfer business, the system would save at least something like $300  to $400 billion annually in pure administrative costs.

$300 to $400 billion looks like a pretty good improvement over the current insurance based system! And it does not include other health policy efficiency improvements like allowing negotiation with big pharmacy for better deals on prescriptions.

More Disturbing Stuff About Trump

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Two new pieces this week from critics of Donald Trump.

Krugman published an editorial, Wrecking The Ship of State. To motivate folks to read the editorial, here are some exerts :

But can we now admit that he really is as bad as — or worse than — his harshest critics predicted he would be? And it’s not just his contempt for the rule of law, which came through so clearly in the James Comey testimony: As the legal scholar Jeffrey Toobin says, if this isn’t obstruction of justice, what is? There’s also the way Trump’s character, his combination of petty vindictiveness with sheer laziness, leaves him clearly not up to doing the job.

Take health care. It’s still unclear whether Republicans will ever be able to pass a replacement for Obamacare (although it is clear that if they do, it will take coverage away from tens of millions). But whatever happens on the legislative front, there are big problems developing in the insurance markets as we speak: companies pulling out, leaving some parts of the country unserved, or asking for large increases in premiums.

…insurance markets were clearly stabilizing last fall. Instead, as insurers themselves have been explaining, the problem is the uncertainty created by Trump and company, especially the failure to make clear whether crucial subsidies will be maintained.

Or take the remarkable decision to take Saudi Arabia’s side in its dispute with Qatar, a small nation that houses a huge U.S. military base. There are no good guys in this quarrel, but every reason for the U.S. to stay out of the middle.

And consider his refusal to endorse the central principle of NATO, the obligation to come to our allies’ defense — a refusal that came as a shock and surprise to his own foreign policy team. What was that about? Nobody knows, but it’s worth considering that Trump apparently ranted to European Union leaders about the difficulty of setting up golf courses in their nations. So maybe it was sheer petulance.

Another shocking piece is Graydon Carter’s Editor’s Letter in the latest Vanity Fair A Farce To Be Reckoned With. Again some exerts:

The thing is, you cannot rise above Donald Trump, you cannot go under him, and you cannot engage him in a conventional way. Before he became president, you could basically ignore him—he was a local joke, after all. Now that he’s commander in chief, you must resist him, with everything that is in you and in every way you can. As anyone who has followed his jerry-rigged career from the 1980s onward will tell you, Trump just drags you to the bottom of the pond every time. Decades ago, he was a short-fingered vulgarian tooling around town in a mauve stretch limo, reeking of Brut.

With Trump, everything past is prologue. On the day after his inauguration, while millions in the U.S. and around the world protested his improbable election, Trump went to C.I.A. headquarters, in Langley, Virginia. The ostensible purpose of the visit was to patch things up after he had repeatedly trashed the intelligence community in the weeks leading up to his swearing-in. Trump’s speech was short, just 15 minutes, but even here, after paying lip service to the C.I.A. and its heritage, he went off piste, claiming that his beef with the intelligence community was a figment of the media’s imagination—as was the slim size of the crowd at his inaugural. These complete fabrications were made despite all printed, oral, and visual evidence to the contrary. That he spoke these words standing before the marble wall of 117 stars representing the lives of the men and women from the agency who had died in the line of duty was troubling enough. Across the hall from him, however—and in plain sight—was another marble wall, with a clearly visible quote from John 8:32 put there by former C.I.A. director Allen Dulles: AND YE SHALL KNOW THE TRUTH AND THE TRUTH SHALL MAKE YOU FREE.

Had Trump heeded those words, his presidency wouldn’t be so trussed up in the Gordian knot of his appalling lies, contradictions, and deceptions. His presidency is effectively doomed—it’s only a question now of how and when it will end. Treason? Impeachment? Incapacity? Until that day, you should be forgiven if you think you are suffering from extreme, full-blown P.T.S.D.—President Trump Stress Disorder. You are not alone. A serial liar in the office or home is one thing—and stressful enough. But a serial liar in the highest office in the land is something else altogether. Couple that with an erratically fragile ego, a severely diminished mental capacity, a lacerating temper, and access to the nuclear codes, and it’s going to get a whole lot hotter in here.

Far and away the most unfit man ever to hold the nation’s highest office, Trump has crammed so much into his first few months that most of us have trouble keeping track of the quotidian acts of executive mayhem. He has no foreign or domestic policy to speak of—he bases most of his decisions on what will play best to his base out there among the Twitterati. He cozies up to dictators and fellow strongmen, flattering them and giving them unwarranted credibility, while running roughshod over traditional allies. He has signed executive orders that attempt to slash decades of advancement in educational, medical, and environmental protections. The torrent of hate that Trump has so cavalierly unleashed has moved attacks against Jews, Muslims, Hispanics, and African-Americans from the margins toward the mainstream. Both the Anti-Defamation League and the Southern Poverty Law Center report spikes in hate crimes and bias-related incidents since Trump’s election

As an executive, Trump is a shambles. Can you imagine a company in America that would hire Trump as its C.E.O.? (Enron doesn’t count: it’s no longer in business.) He’s not a true leader in any proper sense of the word; he’s a ringmaster of a heaving, leaking White House that is much closer to the Circus Maximus or a traveling carny show than any traditional government operation. When he told NBC News that Comey was “a showboat” and “a grandstander,” what he really meant was that there was room for only one of those in this town.

Trump has spoken of the media’s trying to muddy his message of unifying the country. With his brazen attempts to gut government entities like the Environmental Protection Agency, the Department of Energy, and the State Department, as well as his plans to roll back financial legislation such as Dodd-Frank, among so many others, about the only people he is uniting are scientists, economists, environmentalists, health-care professionals, diplomats, career civil servants, parents, children, educators, and other afflicted groups. They have come together in historic droves as they resist the rules of engagement and the reign of terror of the petulant man-child in the Oval Office. And in the end, they will win the day.

 

 

Diverting Attention

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Recent TV news has focused on the “He Said He Said” between Comey and Trump and largely ignored what the Russian Investigation is really about. Comey testified that the Russians had not only intervened in last year’s election, but would try to do it again.

The Russians are attaching the bedrock of our democracy, the election process. Yet Trump says nothing about this problem, only that he would like the investigation to go away. I don’t think he understands or cares about a key part of his job description – To Protect The Constitution of The United States.

Also he clearly does not respect the rule of law. On one point I disagree with Comey. The President is obstructing justice, pure and simple.

Here are some quotes from Comey’s testimony:

“It’s not a Republican thing or Democratic thing — it really is an American thing,”

“They’re going to come for whatever party they choose to try and work on behalf of. And they’re not devoted to either, in my experience. They’re just about their own advantage. And they will be back.”

“There should be no fuzz on this whatsoever. The Russians interfered in our election during the 2016 cycle. They did it with purpose. They did it with sophistication. They did it with overwhelming technical efforts. And it was an active-measures campaign driven from the top of that government. There is no fuzz on that.”

For more see:  Trump-Comey Feud Eclipses a Warning on Russia: ‘They Will Be Back

The Lawless Presidency

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David Leonhardt speaks to Trump’s disrespect for The Rule of Law in an editorial in today’s New York Times. Below are exerts:

Democracy isn’t possible without the rule of law — the idea that consistent principles, rather than a ruler’s whims, govern society. …Even amid bitter fights over what the law should say, both Democrats and Republicans have generally accepted the rule of law. President Trump does not. His rejection of it distinguishes him from any other modern American leader. He has instead flirted with Louis XIV’s notion of “L’état, c’est moi”: The state is me — and I’ll decide which laws to follow.

Let’s walk through the major themes:

LAW ENFORCEMENT, POLITICIZED. People in federal law enforcement take pride in trying to remain apart from politics. I’ve been talking lately with past Justice Department appointees, from both parties, and they speak in almost identical terms. …Trump has erased this distinction. …He pressured Comey to drop the investigation of Trump’s campaign and fired Comey when he refused. …The attorney general, Jeff Sessions, is part of the problem. He is supposed to be the nation’s head law-enforcement official, but acts as a Trump loyalist.

COURTS, UNDERMINED. Past administrations have respected the judiciary as having the final word on the law. Trump has tried to delegitimize almost any judge who disagrees with him.

TEAM TRUMP, ABOVE THE LAW. Foreign governments speed up trademark applications from Trump businesses. Foreign officials curry favor by staying at his hotel. A senior administration official urges people to buy Ivanka Trump’s clothing. The president violates bipartisan tradition by refusing to release his tax returns, thus shrouding his conflicts. …The behavior has no precedent. “Trump and his administration are flagrantly violating ethics laws,” the former top ethics advisers to George W. Bush and Barack Obama have written. …Their attitude is clear: If we’re doing it, it’s O.K.

CITIZENS, UNEQUAL. Trump and his circle treat themselves as having a privileged status under the law. And not everyone else is equal, either. In a frightening echo of despots, Trump has signaled that he accepts democracy only when it suits him. Remember when he said, “I will totally accept the results of this great and historic presidential election — if I win”?

TRUTH, MONOPOLIZED. The consistent application of laws requires a consistent set of facts on which a society can agree. The Trump administration is trying to undermine the very idea of facts. It has harshly criticized one independent source of information after another. The Congressional Budget Office. The Bureau of Labor Statistics. The C.I.A. Scientists. And, of course, the news media.